Estimating Time Saved in MS Clinic Using MS Smart Forms to Retrieve Clinical Data

Background: The lack of standardized data collection tools for people with multiple sclerosis (MS) reduces the quality of MS care. Without a centralized tool, clinicians must spend valuable time re-acquainting themselves with aspects of the patient’s MS course and treatment prior to every appointment, as well as whenever a patient contacts the clinicians. This can lead to recall errors when evaluating patients for changes in clinical data, or making changes in therapy.

Objectives: To demonstrate the utility of the Epic electronic health record-embedded “MS Smartform” in improving speed with which pertinent clinical information, relevant to the care of people with MS, is identified.

Methods: We created the MS Smartform within Epic. The smartform contains information on patient diagnosis, relapse and insidious progression history, disease-modifying therapies, and MRI changes. This MS Smartform was implemented into Epic at the Allegheny Health Network MS Treatment Center. Forty-three consecutively seen patient charts were selected for evaluation. Two neurologists completed a 5-question questionnaire addressing pertinent clinical variables for the selected patients both before and one month after implementation of the smartform (with clinicians using the smartform for the post-implementation questionnaire). The time to complete the questionnaire was recorded as the primary outcome.

Results: A total of 43 patients were reviewed (average age: 49.65y [SD: 8.71y], 21% male, median EDSS: 2.5 [IQR: 2-5.5], mean number of DMTs: 3 [SD: 1.6]). For each DMT a patient had exposed, there was an associated increase in time (62.2s; 95% CI: 38.0, 86.40; p<0.001). The difference pre versus post-smartform was modified by the number of DMTs for which an individual was exposed. The mean time to complete the pre-smartform questionnaire was 219.3s, and 80.3s for the post-smartform questionnaire (-142.4s, 95% CI: -170.6, -114.1; p<0.001), a 63% improvement in time. For patients on increasing numbers of DMTs, there was a greater reduction in time, with a difference of -31.4s (95% CI: -47.2, -15.6; p<0.001) for every additional DMT.

Conclusions: The utilization of the MS Smartform, particularly for patients with more complicated treatment histories, was associated with a significant reduction in the amount of time it took for clinicians to review pertinent patient data in this small, single center pilot study. Ongoing multicenter investigations will evaluate the generalizability of the results. Freely available to all Epic users via the Epic Library, the MS Smartform provides a tool to standardize collection of data and improve quality of care for people with MS. The data can also be leveraged readily for research purposes.